Rheumatoid Arthritis: What is Acceptance and Commitment Therapy?

Separate Yourself From Troubling Thoughts and Emotions

Cognitive behavioral therapy is a form of psychotherapy that teaches people to observe distorted thoughts that are not grounded in reality. ACT doesn’t ask you to evaluate or dispute your thoughts; instead, it recognizes that sometimes our worst thoughts are grounded in reality, but that we can learn to step back and observe them — and the negative emotions they bring up. In this way, we come to accept them, rather than get entangled in them. In many ways, ACT takes its cues from mindfulness, and even from Buddhism’s notion of detachment, or letting go.
Face Your Thoughts and Feelings

“With ACT, we recognize that there are difficult times in life, and people are going to have thoughts and emotions around those difficulties. The tendency is to turn away, but if we can learn to be present to them, that’s more helpful,” says Megan Call, PhD, a psychotherapist and associate director of the Resiliency Center at University of Utah Health in Salt Lake City, and an ACT practitioner.

Be Aware of Your Thoughts About RA Pain

A person experiencing pain from rheumatoid arthritis, for example, might have thoughts about how terrible the pain is, and how it has ruined their life. ACT therapy helps you become aware of the thoughts, and encourages you instead to be mindful. For example, Dr. Call says, “elite runners also experience great pain, but they don’t buy into the notion that it limits them.”
Defuse Thoughts

One of the processes used in a session is called “defusion,” where a thought is noticed with the aim of being able to have a more flexible response to it. A person might name the thought, watch their mental process as if it were a volleyball game and they're on the sidelines, or even give the thought a shape, color, of form.

Once you’ve accepted your reality (the “A” in ACT), you're better positioned to commit to taking actions that align with your values. The name of the therapy, ACT — pronounced as one word — indicates the therapy’s emphasis on helping you define your core values and make changes that are consistent with them.

Speak to Your Rheumatologist

Because medication often cannot control all pain, many rheumatologists are open to the notion of using behavioral therapies to keep the disease from limiting your life more than is necessary.

Still, Gustavo Carbone, MD, a rheumatologist at the University of Miami Health System and assistant professor of clinical medicine at the University of Miami Miller School of Medicine in Florida, cautions people to speak to their doctor before starting this or any therapy. “I am a big believer in cognitive therapies. But first I want to see how much the RA drugs help with the pain, so we can add to or reduce the doses of the drug therapy. Once we have that down, these therapies can help someone who's not in remission deal with lingering chronic pain.”

Know That Small Studies Point to Benefits
In a study published in June 2017 in the journal Annals of the Rheumatic Diseases, scientists examined the results from eight weeks of ACT therapy in more than a hundred rheumatology patients with persistent pain. They found that even six months after the therapy, people reported reduced depression and anxiety, increased pain acceptance, and more engagement in activities. While this wasn't a randomized controlled trial — the gold standard in medical research — the researchers from Ulster University and Limerick University in Ireland conclude that the “positive outcomes suggest ACT is a helpful intervention for people with persistent pain.”

Earlier research published in September 2012 in the Journal of Pain Management queried 67 people with rheumatoid arthritis about the tenets of ACT, asking them to complete questionnaires about their uses of mindfulness, pain acceptance, and values-based action. Patients who were more likely to use these strategies were also more likely to report better health, including less pain. The study also asked whether the participants would be interested in formal ACT therapy, once it was explained to them; around three-quarters thought it would help.

A review published in October 2014 in the Journal of Contextual Behavioral Science analyzed ACT’s effects on chronic pain in controlled trials, and concluded that “ACT is efficacious particularly for enhancing general, mostly physical functioning, and for decreasing distress, in comparison to inactive treatment comparisons.” Still, the authors called for more research on the subject.

Find an ACT Therapist

Six sessions of ACT are considered the minimum number needed to get results. Many therapists suggest 8 or 10, although they caution that some people might need more to get the results they desire.

To locate an ACT therapist, go to the Psychology Today website and enter your city or ZIP code. Once you get a listing of local therapists, click on ACT under the “treatment orientation” category on the left side. You can also click on your insurance provider to find therapists who may take your plan.

A small number of ACT therapists are also listed on the website of the Association for Contextual Behavioral Science, which also has information on the therapy.